Pharmaceutical pollution of the world's rivers.

Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

Retrasplante pulmonar con cross-match positivo en trasplante pulmonar primario complicado con rechazo mediado por anticuerpos / Lung Retransplantation with Positive Crossmatch in Primary Lung Transplantation Complicated by Antibody-Mediated Rejection

La hipertensión arterial pulmonar (HAP) representa el 2,6% de los trasplantes pulmonares (TP), con una mediana de supervivencia condi cional (desde los 30 días del TP) de 9,8 años. Son frecuentes, el rechazo celular agudo (ACR) y la disfunción crónica del injerto (CLAD), mientras que es infrecuente el rechazo mediado por anticuerpos (AMR). El retrasplante pulmonar (RTP) constituye el 4% del TP mundial, debido a complicaciones en la vía aérea, disfunción primaria del injerto, ACR y CLAD. Mujer de 22 años, portadora de HAP idiopática (HAPI) desde el año 2013, trasplantada bipulmonar (TBP) en enero de 2018. A los 16 meses presentó neumonía adquirida en la comuni dad. En una internación posterior, presentó ACR y a pesar de pulsos de metilprednisolona, progresó a requerimientos de cánula de alto flujo y ventilación mecánica no invasiva hospitalaria, caída del VEF1, y tomografía de tórax con vidrio esmerilado difuso y engrosamiento irregular reticular del intersticio subpleural; interpretándose como CLAD a predominio de síndrome de bronquiolitis obliterante (BOS), con presencia de anticuerpos específicos contra el donante (DSA). En enero de 2020 se realizó nuevo TP y ante cross-match positivo, se realizó plasmaféresis y reposición de IgG. Al mes del egreso, no se observaron signos de rechazo en control de biopsias transbronquiales. Entre 2 y 10% de los pacientes con indicación primaria de TP por HAPI son sometidos a retrasplante pulmonar (RTP). La presencia de DSA y el miss-match de HLA, no son contraindicaciones para el RTP.

Pulmonary arterial hypertension (PAH) represents 2.6% of lung transplantations (LT), with a conditional median survival (from 30 days after LT) of 9.8 years. Acute cellular rejection (ACR) and chronic lung allograft dysfunction (CLAD) are common; whereas the antibody-mediated rejection (AMR) is not. Lung retransplantation (LR) accounts for 4% of global LTs for complications in the airways, primary allograft dys function, ACR and CLAD. 22-year-old woman with idiopathic PAH (IPAH) since 2013, who underwent a double-lung transplantation (DLT) in January 2018. 16 months after transplantation she presented community-acquired pneumonia. During a subsequent hospitalization, she presented ACR. Despite the fact that she received pulse methylprednisolone, she required high-flow cannula therapy and hospital non-invasive mechanical ventilation; the FEV1 was reduced and she underwent a chest tomography with diffuse ground glass opacities and irregular reticular thickening of the subpleural interstitium; interpreting the predominance of BOS (bronchiolitis obliterans syndrome) as CLAD, with presence of donor-specific antibodies (DSA). In January 2020, she received a new DLT and due to a positive crossmatch, she was treated with plasmapheresis and IgG replacement. One month after hospital discharge, no signs of rejection were observed at the BTB (bone-patellar tendon-bone) control. Between 2 to 10% of patients with primary indication of LT for IPAH are subjected to lung retransplantation (LR). The presence of DSA and HLA (human leucocyte antigen) mismatch aren't contraindications to LR.

Depresión en universitarios. Diversas conceptualizaciones y necesidad de intervenir desde una perspectiva compleja / Depression in university. Diverse conceptualizations and the need to intervene From a complex perspective

Objetivo: identificar las diversas conceptualizaciones teóricas e investigativas que se han formulado en torno a la depresión en jóvenes universitarios. Materiales y métodos: artículo investigativo desde una perspectiva cualitativa, con reflexiones de segundo orden. La revisión documental permite identificar cuatro categorías de énfasis: en aspectos biológicos, en aspectos descriptivos como lo personal-contextual y académico; una comprensión estructural sistémica y otra sistémico relacional. Categorías que se contrastaron con una entrevista a profundidad, con una joven quien durante su vida universitaria atravesó episodios depresivos, con el propósito de establecer conclusiones que aporten a un abordaje multidimensional. Resultados: producto de la revisión documental se establecen cuatro principales categorías explicativas y de comprensión conceptual: biológico, psicológico, interaccional, y contextual-social; surgen reflexiones en torno a la importancia de considerar una perspectiva integral sobre el abordaje de esta temática. Conclusiones: el análisis de las diversas miradas acerca de la depresión en universitarios invita a realizar un acercamiento holista y contextual a esta realidad. Se concluye la necesidad de un abordaje integral, interdisciplinario, contextual, desde una perspectiva de complejidad, ante entidades complejas que así lo demandan..(AU)

Objective: to identify the various theoretical and investigative conceptualizations that have been formulated around depression in university students. Materials and methods: research article from a qualitative perspective, with reflections of the second order. The documentary review allows four categories of emphasis to be identified: in biological aspects, in descriptive aspects such as personal-contextual and academic; a systemic structural understanding and a relational systemic one. Categories that were contrasted with an in-depth interview, with a young woman who during her university life went through depressive episodes, with the purpose of establishing conclusions that contribute to a multidimensional approach. Results: product of the documentary review four main explanatory and conceptual understanding categories are established: biological, psychological, interactional, and contextual-social; There are reflections about the importance of considering a comprehensive perspective on the approach to this topic. Conclusions: the analysis of the different views about depression in university students invites us to carry out a holistic and contextual approach to this reality. We conclude the need for a comprehensive, interdisciplinary, contextual approach, from a complexity perspective, before complex entities that demand it..(AU)

Presence of PAHs in water and sediments of the Colombian Cauca River during heavy rain episodes, and implications for risk assessment.

In Colombia little attention has been paid to river pollution with Polycyclic Aromatic Hydrocarbons (PAHs). Low environmental control and legislation in such emerging region could significantly contribute to high PAHs releases. In this study, we report the presence of PAHs in water and sediments of the Cauca River (Colombia). Three sampling campaigns were carried out between May 2010 and June 2011, and the samples were collected at eight relevant sites. The sampling time included measuring before, during, and after a season of heavy rains, which were influenced by the global coupled ocean-atmospheric phenomenon, which affected tropical countries with huge flooding, commonly called "La Niña", and/or "El Niño" Southern Oscillation (ENSO). The highest mean ∑PAH concentrations were 4476.5 ng/l and 1582.7 ng/g in water and sediments, respectively. The PAHs most detected were Benzo[b]fluoranthene, Benzo[k]fluoranthene, and Pyrene in sediments; and Fluorene, Acenaphtylene, and Anthracene in water. After the season of rains statistically significant higher PAH concentrations were detected. The results of the study were compared to other rivers worldwide at both environmental compartments, and did not show concentrations of special concern. In some sites, concentrations detected of PAHs were higher than screening benchmarks for ecological protection. Estimation of human health risks was carried out, and the results suggested some likely carcinogenic effects due to PAHs especially in children exposed during current recreational swimming and adults working in low technology sand extraction.

[Evaluation of human health risk for a population from Cali, Colombia, by exposure to lead, cadmium, mercury, 2,4-dichloro-phenoxyacetic acid and diuron associated with water and food consumption]. / Valoración del riesgo en salud en un grupo de población de Cali, Colombia, por exposición a plomo, cadmio, mercurio, ácido 2,4-diclorofenoxiacético y diuron, asociada al consumo de agua potable y alimentos.

INTRODUCTION: Exposure to pollutants such as pesticides and heavy metals has been linked to health problems. Several studies have revealed the presence of these contaminants in Cali; however, there is no information available about the main routes of exposure and risk of these contaminants. OBJECTIVE: To estimate the risk associated with the intake of cadmium, lead and mercury, and pesticides 2,4-D and diuron through the consumption of water and food in a population in Cali. MATERIALS AND METHODS: Population and environmental data were obtained, and a risk assessment was performed using United States Environmental Protection Agency guidelines. RESULTS: The concentrations of the evaluated pollutants were below permissible levels as established by the Colombian Ministerio de Ambiente, Vivienda y Desarrollo Territorial (3 µg/L -1 of cadmium; 10 µg/L -1 of lead; 1 µg/L -1 of mercury; 1 µg/L -1 of 2,4 D; 1 µg/L -1 of diuron). Salema butterfish ( Peprilus snyderi ) samples contained levels of cadmium between 20 and 80 µg/kg -1 , which are below the permissible limit set by the World Health Organization (100 µg/kg -1 ). The results of the risk assessment indicated that the carcinogenic and non-carcinogenic attributable risk to population health from the intake of food contaminants was below the maximum level permitted by the United States Environmental Protection Agency. CONCLUSIONS: It is believed that the findings in previous studies on pollutants may have been due to specific contamination events; therefore, monitoring and early warning about water intake is recommended. Furthermore, the report of cadmium being found in fish consumed as food suggests the need for quality control by regulators.

Valoración del riesgo en salud en un grupo de población de Cali, Colombia, por exposición a plomo, cadmio, mercurio, ácido 2,4-diclorofenoxiacético y diuron, asociada al consumo de agua potable y alimentos / Evaluation of human health risk for a population from Cali, Colombia, by exposure to lead, cadmium, mercury, 2,4-dichloro-phenoxyacetic acid and diuron associated with water and food consumption

Introducción. La exposición a contaminantes como plaguicidas y metales pesados, se asocia a problemas de salud. Diversos estudios revelan la presencia de estos contaminantes en Cali; sin embargo, no existe información sobre las rutas principales de esa exposición y su riesgo implícito. Objetivo. Estimar los riesgos asociados a la exposición a cadmio, plomo y mercurio, y a los plaguicidas ácido 2,4-diclorofenoxiacético y diuron, debida al consumo de agua potable y alimentos en un grupo de población de Cali. Materiales y métodos. Se obtuvieron datos ambientales e información sobre la población, y se valoró el riesgo empleando los modelos de la Environmental Protection Agency (EPA) de los Estados Unidos. Resultados. Las concentraciones de los contaminantes evaluados estuvieron por debajo de las permisibles establecidas por el Ministerio de Ambiente, Vivienda y Desarrollo Territorial de Colombia (3 µg/L -1 de cadmio; 10 µg/L -1 de plomo; 1 µg/L -1 de mercurio; 1 µg/L - 1 de ácido 2,4 diclorofenoxiacético; 1 µg/L -1 de diuron). En las muestras de pescado "manteco" ( Peprilus snyderi ), se detectaron concentraciones de cadmio entre 20 y 80 µg/kg -1 por debajo del límite permisible establecido por la Organización Mundial de la Salud (100 µg/kg -1 ). Los resultados de la valoración mostraron que el riesgo cancerígeno y no cancerígeno atribuible a la ingestión de alimentos y de agua potable con presencia de los contaminantes evaluados, estaba por debajo de los valores máximos admisibles según la EPA. Conclusiones. Se cree que los hallazgos sobre contaminantes en estudios anteriores, pueden deberse a eventos puntuales de contaminación y se recomienda vigilar la bocatoma de agua y emitir alertas tempranas. El reporte sobre la presencia de cadmio en las muestras de pescado, sugiere que el control de la calidad de los alimentos por parte de las entidades reguladoras debe mejorar.

Introduction: Exposure to pollutants such as pesticides and heavy metals has been linked to health problems. Several studies have revealed the presence of these contaminants in Cali; however, there is no information available about the main routes of exposure and risk of these contaminants. Objective: To estimate the risk associated with the intake of cadmium, lead and mercury, and pesticides 2,4-D and diuron through the consumption of water and food in a population in Cali. Materials and methods: Population and environmental data were obtained, and a risk assessment was performed using United States Environmental Protection Agency guidelines. Results: The concentrations of the evaluated pollutants were below permissible levels as established by the Colombian Ministerio de Ambiente, Vivienda y Desarrollo Territorial (3 µg/L -1 of cadmium; 10 µg/L -1 of lead; 1 µg/L -1 of mercury; 1 µg/L -1 of 2,4 D; 1 µg/L -1 of diuron). Salema butterfish ( Peprilus snyderi ) samples contained levels of cadmium between 20 and 80 µg/kg -1 , which are below the permissible limit set by the World Health Organization (100 µg/kg -1 ). The results of the risk assessment indicated that the carcinogenic and non-carcinogenic attributable risk to population health from the intake of food contaminants was below the maximum level permitted by the United States Environmental Protection Agency. Conclusions: It is believed that the findings in previous studies on pollutants may have been due to specific contamination events; therefore, monitoring and early warning about water intake is recommended. Furthermore, the report of cadmium being found in fish consumed as food suggests the need for quality control by regulators.

Occurrence of hydrophobic organic pollutants (BFRs and UV-filters) in sediments from South America.

In the present study the occurrence of emerging hydrophobic organic pollutants in sediment samples from South America (Chile and Colombia) was investigated for the first time. Nineteen Chilean and thirteen Colombian sediment samples were analyzed in order to determine their content of brominated flame retardants (BFRs) (including PBDEs and emerging BFRs) as well as UV filters (UV-F). Samples were collected from neighboring aquatic ecosystems highly urbanized and industrialized in Colombia (Magdalena River area) and Chile (Biobio region). Different analytical procedures were applied depending on the selected analytes, based on chromatographic and mass spectrometric methodologies (GC-MS and LC-MS-MS). In general, concentration levels of both BFRs (up to 2.43 and 143ngg(-1) dw of PBDEs in Chile and Colombia, respectively) and UV-F (nd-2.96 and nd-54.4ngg(-1) dw in Chile and Colombia, respectively) were in the low range of published data, and the contribution of BFRs was higher than that of UV-F for almost all the sampled sediments.

Impacto en la salud y el medio ambiente por exposición a plaguicidas e implementación de buenas prácticas agrícolas en el cultivo de tomate, Colombia, 2011 / Impact on health and environment of exposure to pesticides and implementation of best agricultural practices in tomato production, Colombia, 2011

Objetivo: describir los posibles efectos adversos en salud y medio ambiente por el uso de plaguicidas en zonas productoras de Colombia e implementar las buenas prácticas agrícolas (BPA) en el cultivo de tomate. Material y método: se realizó un estudio descriptivo en el municipio de La Merced-Caldas con tres fases: una de diagnóstico, donde se seleccionaron 132 trabajadores del sector agrícola y se recolectaron muestras biológicas y ambientales. Una segunda fase de intervención en la cual se incluyeron 5 parcelas, en estas se implementaron las (BPA) y una fase de evaluación de estas parcelas. Se llevó a cabo análisis simple de las variables y se exploraron posibles asociaciones. Resultados: el tiempo de exposición a plaguicidas en promedio fue de nueve años. Con mayor frecuencia el sistema nervioso central (95,5 por ciento) fue el más afectado; seguido por órganos de los sentidos (46,2 por ciento); sistema digestivo (33,3 por ciento ); piel (21,2 por ciento) y otros (19,7 por ciento). Se encontraron niveles de organoclorados en el 97,0 por ciento (128), inhibición de la enzima acetilcolinesterasa en el 34,1 por ciento (45) de los participantes y ningún nivel del metabolito etilentiourea. En las muestras ambientales se hallaron niveles de organofosforados en tomate y suelo. En el agua y lodo se detectaron niveles de organoclorados. La producción de tomate, mostró una diferencia estadísticamente significativa entre las parcelas con BPA y las tradicionales (p=0,020). Conclusiones: se evidenciaron los riesgos por uso de plaguicidas y la necesidad de fortalecer la vigilancia sobre los potenciales efectos para la salud que pueden producir los plaguicidas y mediante el empleo de las BPA.

Objective: Describe the possible adverse effects on population health and environment due to pesticide use in agricultural zones in Colombia, and implement the best agricultural practices (BAP) in tomato production. Materials and methods: A descript intoxicative study was carried out in the municipality of Merced-Caldas, consisting in three phases: a diagnostic phase, in which environmental and biological samples were collected, using a sample of 132 agricultural workers. In a second phase, BAP were implemented, and in the third phase, the results were evaluated. A univariate analysis was completed and posible associations were explored. Results: Average length of exposure to pesticides was 9 years. The central nervous system was the most affected (95.5 percent), followed by sensory organs (46.2 percent ), the digestive system (33.3 percent ), skin (21.2 percent) and others (19.7 percent). Organoclorides were found in 97.0 percent (128), inhibition of acetylcholinesterase enzyme was found in 43.1 percent (45); no metabolite ethylenethiourea was found. In the environmental samples, presence of organophosphates was found in tomatoes and soil. In water and mud samples, organochlorides were found. There was a statistically significant difference between BPA farms and traditional farms. (p=0,020). Conclusions: Risks due to pesticide use were demonstrated, and the need to strengthen vigilance on the potential effects of pesticide use.